mannitol: clinical use

Prescribing considerations

• Osmohale is for diagnostic use only in an equipped clinical setting by staff trained in bronchial provocation and acute bronchospasm management.
• Before intravenous use, assess renal, cardiovascular, pulmonary, fluid and electrolyte status.
• Inspect infusion bags for crystallisation and integrity, use a final in-line filter and confirm compatibility before adding another medicine.

Contraindications and cautions

• Osmohale: hypersensitivity, severe airflow limitation, or conditions endangered by induced bronchospasm or repeated forced expiration.
• Infusion: plasma hyperosmolarity, severe dehydration, established anuria, severe heart failure, severe pulmonary congestion or oedema, active intracranial bleeding except during craniotomy, disrupted blood–brain barrier, hypersensitivity, inadequate test response, or progressive renal dysfunction after treatment begins.

Monitoring

• Osmohale: serial FEV1, symptoms and oxygen saturation where indicated.
• Infusion: urine output, fluid balance, renal function, serum osmolarity or osmolar gap, electrolytes and acid–base status.
• Monitor cardiovascular and respiratory function and inspect the infusion site for extravasation.

Clinical pharmacology

Intravenous mannitol is freely filtered, minimally reabsorbed and largely excreted unchanged, producing osmotic diuresis and extracellular fluid shifts. Inhaled mannitol indirectly provokes bronchoconstriction by increasing airway osmolarity and releasing inflammatory-cell mediators.

Formulation and product differences

• Osmohale is supplied as mannitol-only hard capsules with an inhaler; capsules are for inhalation, not swallowing.
• The infusion is a clear, colourless hypertonic solution for intravenous administration.
• Infusion solutions can crystallise at low temperatures and require inspection, handling and filtration.

Solution for infusion

Route: Intravenous

Strengths: 10%, 15% w/v

Capsule

Route: Oral

Strengths: 40 mg